NPIMap

Organization Active NPI

Gainesville Urology, PC

  • Specialist
  • Gainesville, GA
National Provider Identifier
1407872872
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
GAINESVILLE UROLOGY, PC
Practice address
1240 Jesse Jewell Pkwy
Suite 200
Gainesville, GA 30501-3862
Phone
(770) 532-8438
Fax
(770) 535-1785
NPI assigned
Jul 15, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Jodi E Baum
Title
Office Manager
Phone
(770) 532-8227

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X GA Primary

Addresses

Primary practice location

1240 Jesse Jewell Pkwy
Suite 200
Gainesville, GA 30501-3862

Mailing address

1240 Jesse Jewell Pkwy
Suite 200
Gainesville, GA 30501-3862
Phone (770) 532-8438

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040428000434 GA Part B Supplier - Clinic/Group Practice 2567459977 Receives reassigned benefits from 12 practitioners
Practice locations: Demorest, GA; Gainesville, GA; Lavonia, GA

National Provider Directory

National Provider Directory

Locations

1240 Jesse Jewell Pkwy SE
Ste 20
Gainesville, GA 30501

1240 Jesse Jewell Pkwy SE
Ste 200
Gainesville, GA 30501
Phone (770) 532-8438

1240 Jesse Jewell Pkwy SE
Ste 250
Gainesville, GA 30501
Phone (678) 541-5552

355 Clear Creek Pkwy
Ste 1007
Lavonia, GA 30553
Phone (706) 425-5437

Interoperability endpoints

  • Direct secure messaging: davidwoo@gainuro.medalliesdirect.net
  • Direct secure messaging: ryanfogg@gainuro.medalliesdirect.net
  • Direct secure messaging: thomasfassuliotis@gainuro.medalliesdirect.net
  • Direct secure messaging: timothybrock@gainuro.medalliesdirect.net

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1407872872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1240 JESSE JEWELL PKWY",
            "address_2": "SUITE 200",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013862",
            "telephone_number": "770-532-8438",
            "fax_number": "770-535-1785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1240 JESSE JEWELL PKWY",
            "address_2": "SUITE 200",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013862",
            "telephone_number": "770-532-8438",
            "fax_number": "770-535-1785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GAINESVILLE UROLOGY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-15",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "BAUM",
        "authorized_official_first_name": "JODI",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "770-532-8227",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.